CMS Issues Guidance on Hospital Inpatient Admissions

James Carroll and Ben Amirault, for HealthLeaders Media
, January 27, 2011

While the references may prove to be a convenient point of reference, the release may also pose a bit of a challenge for providers, according to Deborah Hale CCS, CCDS, president and CEO of Administrative Consultant Service, LLC, in Shawnee, OK.

"The list of factors for determining medical necessity provided in this article places hospitals in a difficult position regarding compliance with their statutory obligation to assure that services are provided economically and only when, and to the extent, they are medically necessary (42 CFR 1004.10(a))," she says.

She continued, "Certainly one can understand the need for physician judgment to determine that an admission is unnecessary but to say that a hospital can't depend upon screening criteria to determine that an admission is necessary becomes a challenge."

James Carroll is associate editor for the HCPro Revenue Cycle Institute. HCPro Associate Editor Ben Amirault contributed to this article. To read the special edition MLN Matters article, click here.